Individual
GEORGE C-C FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
330 BARCLAY AVE NE, SUITE 203, GRAND RAPIDS, MI 49503-2556
(616) 391-2313
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301078543
MI
2080P0208X
Pediatric Infectious Diseases Physician
Primary
4301078543
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4627622
—
MI
Enumeration date
07/27/2006
Last updated
03/17/2021
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